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Friday, June 29th 2007

Shocking News: JAMA Jumps To Publish An Anti-P4P Study

That Medicare PMHQID program doesn’t have such amazing initial results. So says a JAMA study (H/T Kevin, MD).

Researchers looked at information from hospitals treating 105,383 patients over three years beginning in 2003. They evaluated such factors as whether the hospitals prescribed aspirin and widely accepted cardiac drugs called beta-blockers and ACE inhibitors, and whether patients were counseled to quit smoking.

Compliance rose to 94.2% from 87% at the pay-for-performance hospitals. At the others, compliance also rose, to 93.6% from 88%. Researchers found a “slightly higher rate of improvement for 2 of 6 targeted therapies” but concluded that “overall, there was no evidence that improvements in in-hospital mortality were incrementally greater at pay-for-performance sites.”

It’s possible the financial penalties for not complying weren’t sufficient. “Those with the poorest performance risked future financial penalty,” researchers said, but didn’t actually pay such a penalty. Bonuses for complying with performance standards totaled $17.6 million to a total of 123 hospitals in the first year and 115 hospitals in the second year.

“One read on this is that the carrots have to be bigger,” Duke’s Dr. Peterson said. Hospital officials involved in the Medicare pilot project said this winter in a conference call with reporters that financial incentives were small relative to their budgets.

But seriously, this doesn’t tell us anything does it? This hospital program is counting on Medicare to punish hospitals and then hospitals to pass on the financial punishment to providers?

And as the study appears to admit, there’s a good chance there simply wasn’t enough incentive to promote…adequate change.

We All Know This Is Why P4P Is Coming

Pay-for-Performance is coming from CMS, in order to save some cash. But whatever their primary motives isn’t compensation being tied to performance – as long as it is implemented right – part of the same accountability and transparency physicians are calling for from all other players in the American health care system. I certainly know I think we need more transparency and accountability for payers and for pharma and others.

It isn’t like physicians are far and above better in those departments than insurance or drug companies. Let’s work towards it and some form of P4P can, and should, be part of that.

Just kidding about the JAMA thing.